Popovici A, Petca A, Grigoroiu M, Nica A
Clinica de chirurgie generală, Spitalul Clinic Fundeni.
Chirurgia (Bucur). 1997 Nov-Dec;92(6):387-97.
Between 1980 and 1996, 16 patients (10 women) with pathologically confirmed insulinomas were operated on; they represents a median of 0.9 per year and 1.1 per cent from the total of pancreatic tumors. Median age was 47.2 (+/- 22.8) years old (range 23-68). Insulinomas occurred with following frequency in: head--2 patients, body and tail--11 patients and diffuse forms (nesidioblastomas)--3 patients. The specific clinical forms only with tumoral syndrome (without hypoglycemic manifestations) and one was an intraoperative discovery. In the case of the four patients two presented with splenic-portal hypertension +/- upper digestive haemorrhages and the other two only tumoral syndrome. The surgical approach was: the midline (ten), uni- or bilateral subcostal (five), and other incisions one. There were performed tumor exeresis through: enucleation (three), segmentary pancreatectomies (two), spleno-left-pancreatectomies (nine) and the extension of an anterior pancreatectomy (one). In one case biopsy alone was done. The tumors were not intraoperatively identified in three cases (blind left spleno-pancreatectomies). The malignancy index was 4/16 (25 per cent). Postoperative mortality rate was 12.5 per cent (two patients: one acute necrotizing pancreatitis and one pulmonary embolism).
1980年至1996年间，对16例经病理证实的胰岛素瘤患者（10例女性）进行了手术；每年平均有0.9例，占胰腺肿瘤总数的1.1%。中位年龄为47.2（±22.8）岁（范围23 - 68岁）。胰岛素瘤发生频率如下：胰头——2例，胰体和胰尾——11例，弥漫型（胰岛细胞瘤）——3例。仅表现为肿瘤综合征（无低血糖表现）的特定临床类型有1例，为术中发现。4例患者中，2例伴有脾门静脉高压±上消化道出血，另外2例仅表现为肿瘤综合征。手术入路为：正中切口（10例），单侧或双侧肋下切口（5例），其他切口1例。通过以下方式进行肿瘤切除：摘除术（3例），节段性胰腺切除术（2例），脾 - 左胰腺切除术（9例），扩大的胰头切除术（1例）。1例仅进行了活检。3例术中未发现肿瘤（盲目行左脾 - 胰腺切除术）。恶性指数为4/16（25%）。术后死亡率为12.5%（2例患者：1例急性坏死性胰腺炎，1例肺栓塞）。
